Is universal screening for thyroid disease in pregnancy a cost-effective strategy?

Abstract

Research over the past decade has documented multiple adverse effects of subclinical hypothyroidism and autoimmune thyroid disease on pregnancy outcomes. Nonetheless, the issue of universal screening for thyroid disease in pregnancy remains controversial. In this Practice Point commentary, we discuss the study of Dosiou et al., which assessed whether universal screening is a cost-effective strategy. The authors generated a state-transition Markov model that evaluated the cost-effectiveness of three screening strategies. Universal screening with either TSH levels or thyroid peroxidase (TPO) antibodies was found to be cost-effective under nearly all assumptions; however, the model was limited by the choice of potential adverse outcomes selected by the authors. Specifically, the effect of treatment on reducing the incidence of miscarriage and preterm delivery was not addressed, and the inclusion of gestational hypertension is compromised by the lack of prospective intervention trials. We recommend that a targeted case-finding approach should remain the standard of care until new data become available.